ADDING TO THE CHINESE MATERIA MEDICA

Since publication of the first Chinese herbal, the Shen Nong Ben Cao Jing (ca. 100 A.D.) with 365 herbs, there have been numerous revisions. By the end of the 16th Century, more than 1800 items were included in the intensively revised Materia Medica produced by Li Shizhen, the Ben Cao Gang Mu. Modern Chinese herbal compendia contain up to 6,000 items, though this proliferation is largely due to improved botanical differentiation of herbs used in different parts of China for the same applications and under the same Chinese name. For all practical purposes, it can be said that about 1,000 items are in common use today, including animal and mineral materials. Of these, about 10-20% are imported by China either because the original and best source is elsewhere (primarily India and the Middle East) or because of shortage of domestic supply.

Herbs from foreign sources have frequently been mentioned in Chinese medical books throughout the long history of Chinese writing. The Old Silk Road, as it is now called, was also a spice and medicine trade route; myrrh and frankincense are examples of items imported by China. The incorporation of foreign materials dramatically increased with the development of sea trade during the past three centuries. For example, Chinchona bark, introduced by Western missionaries, was imported from Peru for the treatment of malaria. American ginseng, recognized by missionaries based on botanical similarities with Chinese ginseng, was imported in massive quantities since the 18th century as a substitute for the dwindling supply of Chinese ginseng, and later classified as a separate item. India, the original source for China's supply of common spicy herbs such as ginger, pepper, and cardamon, within the last century provided many of the additions to the Chinese Materia Medica over the centuries.

In this article, I propose the addition of a new herb, called "kava," to the Chinese Materia Medica and describe its categorization. The herb grows in the South Sea Islands and at one time its range included the Philippine Islands in the South China Sea, not far from China's Hainan Island. It is proposed here that kava might be grown on Hainan in order to support use in China without the need for major foreign import. According to reports, the cultivation of kava in the Pacific Islands is sometimes carried out by overseas Chinese workers who could thus provide the necessary knowledge and experience. Since the best roots are obtained from plants which have been cultivated for several years, the herb would be imported during the first few years of use. Currently, kava cultivation is mainly limited to Fiji, but wild stock of superior quality can be obtained from the island of Hawaii.

WHAT IS KAVA?

Kava refers to the rootstock of the plant Piper methysticum. Information about this herb has largely been obtained from a comprehensive report made 30 years ago by Steinmetz, which was edited and republished in part in the Journal of the Institute for Traditional Medicine in 1985. Recent studies have been undertaken, in part, because of the increased utilization of kava drinking as a substitute for alcoholic beverage consumption, especially among the indigenous people of Australia and the South Pacific islands. In 1992, a new book, Kava: The Pacific Drug, was published as part of a series on psychoactive plants of the world. Standardized extracts rich in kava lactones have been produced in Germany for use as a sedative agent, and this material is now used, though only to a limited extent, in herb products throughout Western Europe and the U.S. The Institute for Traditional Medicine has produced three formulations (one for external use) combining kava with Chinese herbs, described later in this report.

The plant is found growing as far east and as far north as the Hawaiian Islands, and as far South as Fiji. The natural range is hence established as between 23 degrees North or South of the equator, and thus within the range of the Southernmost part of China. It has always been found on islands, perhaps preferring the volcanic soil, and it grows best at altitudes greater than 1,000 feet. Thus a tropical mountainous island will serve as a likely site for cultivation. Hainan and Taiwan fit these criteria. Hainan is one of the native regions for growth of Piper nigrum, a relative of kava.

BOTANICAL RELATIONS

Kava is a member of the Piperaceae (pepper family). This plant family is well-known for its spicy tasting and warming materials, such as the common black pepper used worldwide as a condiment and medicine.

Among the Piper species commonly used in China and Southeast Asia are the following, described in the compendium Medicinal Plants of East and Southeast Asia by L. Perry:

Piper betle: an herb used in the "betel chew" (with areca seed as the main component). The leaves are used to wrap the main ingredients and they are said to affect the nerves, digestive system, and salivary system. The root, leaves, and seeds may all be used medicinally. The plant is aromatic, and it is also considered to be tonic, expectorant, and stimulant. It is said to be prophylactic for dysentery and fevers, possibly because of anti-bacterial activity (it is used externally to cleanse wounds and to treat skin ulcers). The herb contains several phenols, including eugenol and chavicol derivatives.

Piper cubeba: the fruits are used, predominantly as a digestive aid (carminative and stomachic); it is also used for treating sunstroke; In Taiwan it is used to treat gonorrhea. In Indonesia and on the Malay Peninsula, it is valued as an antiseptic diuretic (for genitourinary infections), and it has long been used to treat gonorrhea. It is also used as a sialagogue and digestive aid. Western herbalists use it in the same ways as their Asian counterparts, but it is also considered by these practitioners to be useful for lung disorders.

Piper longum: this hot pepper is mostly obtained by the Chinese from India. The fruit is used as a digestive aid (stomachic); it is also used for urinary problems, sunstroke, and lung disorders; hence it is quite similar in action to cubeb fruits. It is said to dissipate phlegm. The fruit, root, and flower are all used.

Piper nigrum: this is ordinary black pepper, native to India. It is used as a digestive aid (stomachic and carminative), a diuretic, and a component of prescriptions used to treat "summer heat" disorders as well as many types of cold disorders. It is used extensively in the treatment of abdominal pain. In many countries it is included in tonic preparations.

Piper retrofractum: this pepper is used in Indo-China and Thailand. It is valued for various feverish diseases, including liver disorders with jaundice, and for migraine headache. In Malaysia it is used as a postpartum tonic. It is a component of digestive and sudorific (sleep-inducing) preparations. The roots are chewed for toothache and the root decoction is used for digestive disorders including stomach ache. It is included in many tonics, and it is used to disperse liver congestion.

Piper sarmentosum: this pepper is used in India and South China as well as Indonesia. It is used for feverish diseases, for digestive disorders, and toothache. The extract may be applied externally to treat pain in the bones. When the root is chewed with betel nut, it is said to be helpful for the treatment of coughs and asthma; with nutmeg and ginger it is used to treat pleurisy.

Piper kadsura: this pepper is used as a stomachic, expectorant, and stimulant.

Many other Piper species are used in the medicinal traditions of East and Southeast Asia, with properties and uses similar to those cited above. It can be seen that, in general, the Piper species are used for digestive disorders, genito-urinary tract infections, for local pain (such as toothache), for cough, and for certain types of feverish diseases. Virtually all these species have external uses, primarily as antiseptics (this corresponds with the internal use for treating urinary infection) and for rheumatic pains and headaches (corresponding to the common topical use for treating toothache).

In summary, the Piper species can be said to be digestive (carminative and stomachic), antiseptic, analgesic, and antipyretic (for sunstroke and certain fevers). Except for two materials, betel and Piper retrofractum, only the fruit is used; in the case of Piper retrofractum, the root has analgesic properties, possibly due to similar active components as found in kava.

PIPER SPECIES IN THE CHINESE PHARMACOPEIA

The species of Piper which are currently of major importance in Chinese medicine are classified as follows (descriptions from Oriental Materia Medica by Hong-yen Hsu):

Haifengteng, obtained from Piper hancei, is said to be spicy and bitter, warming, and affects the liver and spleen. It is used primarily for rheumatic problems affecting the joints. The rhizome is used.

Bibu, obtained from Piper longum, is said to be spicy, hot, and affects the stomach and large intestine. It is used for gastric pain, vomiting, intestinal disorders, headache, and toothache. The herb is mostly obtained from India. The fruit is used.

Hujiao, obtained from Piper nigra, is said to be spicy, hot, and affects the stomach and large intestine. It is used to treat excessive phlegm, vomiting, diarrhea, and abdominal pain. The fruit is used.

Pichengqie, obtained from Piper cubeba, is said to be spicy, warm, and affecting the spleen and kidney. It is used for vomiting, hiccoughs, abdominal pain, and diarrhea. The fruit is used.

These herbs are classified as being spicy, warming, and are in the category of dispelling internal chill, except haifengteng (the only one for which the underground portion is used), which is in the category of dispelling draft-damp. In general, they affect the stomach and/or spleen in relation to their treatment of abdominal pain, diarrhea, and vomiting.

PROPERTIES OF KAVA

Kava is described by its users as being spicy but not bitter, consistent with most of the other Piper species. The taste is rather easy to evaluate because the spicy nature is so prominent. Its analgesic properties produce a numbing sensation on the tongue when the root is either chewed or consumed as a decoction. Its uses in the South Pacific Islands include soporific and narcotic, analgesic, and urinary disinfectant (especially for gonorrhea). It is reported to be stomachic, diuretic, and diaphoretic. In addition, it is reputed to induce easy labor and promote flow of milk. It is taken during convalescence as a tonic. It has been adopted for use in Germany, where additional indications have been suggested, including bronchitis, diarrhea, rheumatism and gout, nephritic colic and edema, genito-urinary inflammation.

It is easily seen that these uses of kava are consistent with those of the other Piper species, but the emphasis on digestive treatment is distinctively less (though it is reported to be stomachic and a treatment for diarrhea) while the sedative and analgesic properties as well as the disinfectant properties are predominant.

It may be said that Kava, like the other species, probably affects the stomach, but that it also affects the heart (because of effects on sleep and dreaming) and kidney (because of its effects on edema, genito-urinary inflammation, rheumatism, and gout).

CHEMICAL CONSTITUENTS

The bulk of dried kava root (80% of the fresh root is water) is made up of carbohydrates, primarily starch (about 40%), fiber (20%), and a small amount of simple sugars (about 3%) plus remaining moisture (about 12%), accounting for about 70% of the dried root material. There is also about 3.5% each of proteins and minerals. From 3 to 20% of the root is made up of pyrone derivatives (including the complexed forms called lactones), of which the base substances are kawain (which has recently been described as dehydrokawain) containing an alpha pyrone, and yangonin, containing a gamma pyrone ring. Derivatives of kawain found in the root include dihydrokawain (hence, "dihydro-dehydrokawain"), methysticin, and dihydromethysticin. Derivatives of yangonin present in the root include dihydroyangonin and desmethoxyangonin. There is also a saturated derivative of kawain, dihydrokawa-acid in which the pyrone ring is broken.

According to modern reports, the kava pyrones all show a centrally acting (spinal) relaxation of skeletal muscles and reflex irritability. They are also local anesthetics and antipyretics (which may be due to vasodilatory action). Kawaic acid, a derivative of kawain, is reported to produce numbness of the tongue when tasted, indicating a local anesthetic action. The action is somewhat like that of cocaine, and, in fact, it can be used as a corneal anesthetic much has cocaine has been used. In Fiji, kava was used during the practice of tattooing in order to relieve pain, taken orally in large doses and applied topically.

Dihydrokawain (DHK) is produced during the aging of the root. Fresh roots contain only 0.2% of this material, but the root dried for one year contains up to 1% and older roots may have up to 3%. It is likely that kawain is altered to become dihydrokawain with aging. It should be noted that this is the reverse of an oxidation process.

DHK induces sleep in mice and rats within 20 minutes after administration. In one such experiment, using 50 to 200 mg/kg orally (which would correspond to a human dosage of whole root material of one to four kilograms), the lack of side-effects was clearly demonstrated.

DHK is not very soluble in water, and so the effects are best obtained by ingesting the powdered herb (it can be extracted in vegetable oils however). It was reported by Steinmetz that a strong narcotic effect of kava would be obtained by chewing the root extensively before use and that the narcotic action was not found in beverages made without this processing first. It seems likely that the chewing helped liberate active constituents, and it is also possible that the action of saliva enzymes coupled with plant enzymes already present may have converted some of the active constituents to a more assimilable form.

Kawain, dihydrokawain, and related compounds have recently been isolated in Japan and Taiwan from another plant, Alpinia speciosa. These compounds were tested for possible effects on gastric ulcer, by evaluating its ability to inhibit excessive gastric acid secretion induced by various drugs. It was found effective for this purpose. These compounds counteracted the effects of histamine for more than five hours, and of tetragastrin for about four hours. They also had some effect on gastric acidity caused by carbachol. Repeated studies of this nature have confirmed that kawain and DHK are important active constituents and that they are effective against chemically induced ulcer.

It is likely that other species of Alpinia contain kawain and DHK as well as related compounds. There are several types of alpinia used in Chinese medicine, including:

Liangjiang, from Alpinia galanga: the rhizome is used predominantly but the fruit has similar actions; it is spicy and hot, and affects the stomach and spleen. It is used for stomach pain, vomiting and diarrhea, and indigestion. It also has strong antibacterial actions. Traditional formulas containing this herb are used in Japan for treatment of gastric ulcer.

Caodoukou, from Alpinia katsumadaii: it has a spicy taste, warm energy, and affects the spleen and stomach; it is used for abdominal and chest pain, vomiting of acid, and diarrhea. The fruit is used.

Yizhiren, from Alpinia oxyphylla, has a spicy taste, warm energy, and affects the spleen and kidney. It is used for abdominal pain, vomiting, diarrhea, and nocturia.

It is interesting to note that these species all have the spicy and warm property and relieve abdominal pain, vomiting, and diarrhea. These actions are similar to the effects of the Piper species. Alpinia speciosa, the variety which thus far was shown to contain DHK, is used in Taiwan as a substitute for cardamon (sharen) in traditional herb formulas; sharen is also spicy, warm, and used in the treatment of stomach pain, vomiting, and diarrhea. All these species affect the stomach and/or the spleen.

RELATED CHEMICAL COMPOUNDS

Methysticin, one of the major kava pyrones, has a structure similar to the well-known compound safrole attached to the basic kava pyrone ring. Safrole is found in the American herb sassafras which also causes a numbing sensation on the tongue; it is primarily an anodyne, antiseptic, diaphoretic, diuretic, and stimulant-consistent with the properties of kava except that kava (which is stimulant in some situations) is predominantly sedative. Safrole is considered the main active ingredient in sassafras. Interestingly, one of the main uses was to treat venereal diseases, such as gonorrhea.

All these agents are warm and spicy and they either affect the stomach/spleen (treating abdominal pain, diarrhea, and vomiting) or heart (treating pain and dispersing phlegm).

This same ring structure found in methysticin is found in other piper components, such as piperine and chavicine, probably derived along a branch of the same biosynthetic pathway as methysticin. Related compounds with this structure from various Piper species are piperlonuminine, futoamide, and methyl piperate.

The kava pyrone of kawain is attached to a cinnamic acid type structure. Cinnamic acid is found in balsamic resin of the herb Anxixiang (benzoin), which is neutral, spicy, and bitter, affecting the spleen, stomach, heart, and lungs. It opens the orifices, dispels phlegm, and is a strong disinfectant. It also promotes blood circulation.

The kava pyrone in yangonin and dihydroyangonin is attached to an esdragol-type moiety. Esdragol (methyl chavicol) is found in several Chinese herbs:

Again, all of these are warm and spicy in nature, and all affect the spleen/stomach. The properties are similar to those of kava.

The yangonin ring moiety attached to the main pyrone is also similar to methoxy-benzylacetone, which is the main ingredient in the oil of chenxiang (aquilaria); this herbs is warm, spicy, and bitter, affects the spleen, stomach, and kidney. Used for epigastric pain, vomiting, and asthmatic breathing. It also contains a large amount of benzylacetone which is similar to the ring structure of kawain and DHK.

It appears evident, from the above comparisons, that the alpha and gamma pyrone rings, while important to the action of kava components, may not be the most critical aspect of these constituents: rather, it is the compounds attached to the rings that are of major importance. The other herbs mentioned here, with activities similar to kava and similar chemical structures among their active components, do not appear to contain the pyrone (which is rather unique among molecules isolated from Oriental plants).

The influence of the group attached to the basic pyrone was demonstrated by recent work in Taiwan, with evaluation of kawain derivatives in the treatment of stress-induced ulcer. Kawa pyrones were produced by a synthetic method, with varying attached structures. No response at low dosage (40 mg/kg) was obtained for most of the compounds (including kawain), but remarkable effects (comparable with the drug cimetidine) only when the pyrone was attached to a hexanyl group. Kawain was effective (in other studies) at a higher dosage (300 mg/kg).

HERBS OF DIFFERENT BOTANICAL NATURE WITH SIMILAR ACTIONS

There are numerous cases in Chinese herbal medicine where Materia Medica items of very diverse origin being used interchangeably. Matching of clinical application is one method of obtaining an accurate classification. Consider these herbs in relation to kava:

Yuanzhi (polygala), derived from Polygala tenuifolia, is spicy and bitter and warm, affecting the heart, kidney, and lungs. It has a sedative action, and it is also used for treatment of bronchial disorders with excessive phlegm (as is the case with many Piper species).

Shichuanpu (acorus), derived from Acorus graminae, has a spicy taste and warm energy, and affects the heart and liver. It is used to treat spasms, excessive dreaming, arthralgia, and diarrhea. It is also diuretic.

Tanxiang (sandalwood), from Santalum album, is spicy and warm; it affects the stomach, spleen, and lungs. It is used to treat epigastric, chest, and abdominal pain, and for vomiting. It is diuretic and disinfectant, used in India and elsewhere to treat urinary tract infections and is valued as a sedative in Tibetan medicine.

Xixin (asarum), from Asarum sieboldii, is spicy and warm, and affects the heart, lung, and kidney. It relieves pain, especially toothache, sinus pain and arthritis. It contains asarinin and other components with a safrole ring, and also contains safrole. Recent studies in China have shown the essential oil, which contains these components, to have marked sedative properties.

PROPOSED CLASSIFICATION: ENERGY AND TASTE

It is evident from the above descriptions that from both a botanical and chemical viewpoint, kava must be classified as being warm and spicy. Every item thus far identified in the same genus (Piper) or from other genera with similar actions or with similar chemical components has a warm and spicy nature (except benzoin which is neutral). Consistently, these materials are analgesic, disinfectant, and anti-spasmodic. They treat gastro-intestinal disorders, especially vomiting and diarrhea.

The current, limited literature regarding kava focuses attention on the soporific, analgesic, antispasmodic, and anti-bacterial effects of the herb. Commonly, Chinese herbs with analgesic and antispasmodic effects are warming, and those with soporific and antibacterial effects are cooling. However, these are generalizations. For example, sandalwood is a spicy warming herb which also is a urinary disinfectant (in fact, the combination of sandalwood with kava has been used in Europe for treatment of urinary infection).

The warming quality of herbs is often quantified, such as slightly warm, warm, or hot. Kava is not especially warming based on its reported actions, and it has been stated that "it does not raise the temperature." The taste is not as biting as that of herbs classified as hot, (e.g., cinnamon bark, evodia, and zanthoxylum) and the acrid taste of the root is notably less than that of some of the pepper fruits. Tentatively, the herb should be classified as warm.

PHARMACOPEIA CATEGORY AND MERIDIAN AFFECTS

Kava is reported to induce a deep dreamless sleep. Chinese herbals frequently refer to excessive dreaming as a syndrome of the heart. Actually, as has been described elsewhere, kava has an action which, depending upon the dosage as well as method of preparation, may either inhibit or intensify dreaming. Nonetheless it is consistently effective as a treatment for insomnia.

The other Piper species mentioned here which also treat stomach pains, are classified predominantly as herbs for dispelling chill; this also applies to some Alpinia species. However, this does not seem the best category for kava. For all its use in South Pacific Islands and more recently in Europe, there are relatively few references to its treatment of abdominal pains, vomiting, and diarrhea, which is probably the hallmark of the abdominal cold syndrome.

The herbs classified as having a strong sedative action are generally of cold energy (exception: rhododendron, which is also strongly analgesic; it is warm and spicy and affects the heart, spleen, and lung). They are used in the treatment of heart palpitations, frequent dreaming, and insomnia. The nourishing sedatives generally have a neutral energy (exception: polygala, spicy and warm), and treat insomnia, heart palpitations, and profuse perspiration. It has been suggested that kava increases the force but decreases the rapidity of heart action, and it may thus be of some use in treating palpitations. It has also been said that the person who takes kava "does not talk loudly, or become quarrelsome, on the contrary, he is tranquil and friendly."

Kava is said to produce a profound dreamless sleep within half an hour. The same type of effect can be obtained with zizyphus seed. The question of whether kava ranks as a heavy sedating agent or a nourishing agent might depend most on whether or not it has nourishing activities. The fact that it is given "to the sick and convalescent" might suggest the latter, and so as a tentative classification, it can be recorded as an herb that nourishes the heart and calms the spirit, much like the herbs polygala and zizyphus.

Action on the heart is further suggested by the report that it causes short term euphoria but it does not impair mental alertness. It appears to affect the spirit, and in a more nourishing manner. The main active constituents, kawain and yangonin derivatives, are anti-spasmodic and sedative; according to modern reports, the various active ingredients are approximately the same in action but unequal quantitatively in their efficacy as relaxers of skeletal muscles. Suggested use in Europe of this herb for hypertension is possibly based on the antispasmodic action lowering peripheral resistance to blood flow. Other herbs with sedative and antispasmodic effects of recent worldwide interest include rauwolfia from India and white sapote from Mexico. Both seem to have sedative action related to antispasmodic activity.

The anti-bacterial action, which is topical and which is intact upon urinary excretion, is probably of secondary importance from a Chinese perspective. For example, other Piper species have this property but it is not emphasized in the Chinese Materia Medica or in the categorization of those plants. Neither is it particularly important from a modern perspective because of the efficacy of modern antibiotics.

It is proposed here that kava be assigned to the category of herbs that nourish the heart and pacify the spirit, and to "meridian entrances" of the heart, stomach, and kidney.

Using kava chronically in large doses produces skin lesions, weakening of eyesight, and emaciation. It is believed that the skin disorder arises from liver poisoning due to accumulation of alkaloids, present in only small quantities in the root, but excreted very slowly. Emaciation may occur because of depression of appetite (perhaps suppression of acid production), and eyesight weakness may be a result of chronic over-relaxation of the eye muscles. As a contraindication, regular ingestion of substantial doses of kava should be avoided in persons with liver disease.

EXAMPLE OF USE OF KAVA IN MODERN HERBAL PRESCRIPTIONS

The current author has designed two formulations based on using kava as a sedative. The first, developed in 1987, includes the following herbs:

kava

oyster shell

schizandra

succinum

dragon bone

Here, kava is used like the herb polygala, as a heart nourishing component which has sedative action. Schizandra, an astringent herb, has been shown to improve cerebral function and to act as a sedative. It may aid treatment of insomnia by regulating cerebral discharges in the breathing area of the brain. One cause of night-time waking is dyspnea due to irregular cerebral functions. Schizandra is a major component of the patent medicine Cerebral Tonic Pills, indicated for insomnia. Dragon bone and oyster shell are both classified as heavy sedating agents. They are calcium sources that may act as nutritional antispasmodics, and they counter excessive stomach acidity. Thus, these herbs will help treat many cases of gastric ulcer. Succinum is another heavy sedating agent; it promotes blood circulation and diuresis.

This formula, produced under the name Schizandra Dreams (Chinese Traditionals label by Health Concerns), has many of the basic actions of kava, treating insomnia and influencing dreaming, relieving spasm, treating cough with excessive phlegm, and alleviating gastric ulcer and hyperacidity of the stomach.

Another prescription using kava was developed in 1995:

Kava

Zizyphus

Melatonin

Zizyphus is a heart-nourishing sedative that has short-term (immediate) effects on inducing sleep, and also long-term effects (calming the heart by nourishing heart blood). Melatonin is a hormone that has a 24 hour cycle, rising to highest levels during sleep. Persons who have sleep disorders often respond to administration of melatonin, indicating that it is one of the sleep cycle components of the body. It is reported helpful in entraining the daily cycle following time zone transitions (jet lag). The poor sleep that occurs with aging is thought to be partly a result of reduced output of melatonin. This formula is produced as a tablet under the White Tiger label by ITM, called Melakava. The intended use is solely as a before-sleep supplement, usually taken in doses of 2-3 tablets.

The topical compound developed in 1988 by the current author, and modified more recently by the manufacturer, is an alcohol extract of the following ingredients:

kava

Corydalis

Calamus

Myrrh

Catechu

Frankincense

Sanqi

Borneol

Carthamus

The original formulation was based on resinous herbs and the formula was called Resinall-K (all resin formula with kava) to be used for skin infections and for local pain. The new formulation, called New Resinall K, includes sanqi, carthamus, and corydalis, which shifts its functions towards treatment of pain due to injury. It is produced under the Chinese Traditionals label by Health Concerns.

CONCLUDING REMARKS

This article demonstrates some of the considerations that can go into placing a "new" herb into the traditional Chinese Materia Medica. While some aspects have been considered in a very lengthy fashion (active constituents, botanical relatives), the basic approach can be applied to other cases. By contrast, several authors who have some training in Western herbalism and some training in Chinese herbalism, have compiled extensive lists of Western herbs that they have classified by Chinese terminology, indicating nature (hot, warm, neutral, cool, cold), taste traditional category, meridians affected, and so on. Frequently, there is little or no justification given for the classification. The current author considers that such an off-hand approach to the process of integrating herbs into the vast, complex, and sophisticated Chinese tradition (which now includes many centuries of medical experience plus many decades of modern research) is highly disrespectful of all the hard work, skill, and wisdom of the Orient, and can only be viewed as a loss to both Western and Oriental herbalism. It is as if the contribution of thousands of Oriental medical doctors, scholars, and researchers is only worthy of a little study and then it can all be grasped and utilized in a matter of months. Hopefully, traditional medicine will not be so easily subsumed to the (frequently disastrous) quick and easy engulfment of a modern society that has lost touch with its origins.